Uncommon Sense

February 19, 2020

Costing Out Medicare for All

There is still a great debate going on as to whether we can afford Medicare for All. I prefer, rather, to use the term Universal Healthcare (UH) as I do not want to be restrictive in what we can come up with. Maybe Medicare for All is too expensive but a better plan is actually cheaper, etc.

The first stage of this discussion is the one we need now, which can be couched in the form of a single question: Is there enough information to believe we can afford UH to vote politically to have such a thing?

The answer is a clear yes. Other Western countries have better health outcomes or equal health outcomes than we get here and they pay far less for those outcomes.

Therefore we can afford to do UH and we should vote to do so.

The big question is then “Can we do it well?”

Those who believe in American Exceptionalism (U . . . S . . . A . . . U . . . S . . . A . . . !) must believe that not only can we do it, we can do it better than those other countries, especially the shit hole countries.

But, but “God is in the details!” (Not the Devil, people, get it right!) Yes, that is true, but any details being offered up in the current campaign for president are irrelevant because they are non-binding. We can also count on doctors working to protect their earnings. We can count on Big Pharma working to protect their immense profits. We can count on actual costs going down naturally, if for no other reason than Health Insurance company profits will no longer be extracted as rents from the system (see Addendum below).

The attractive thing about Medicare for All is that it has a proven track record of service, of frugality (3% operational overhead), and acceptability. That is political thinking however.

We could either: put health insurance companies out of business or allow them to offer supplemental insurance coverage (true catastrophic insurance) or we could do what Switzerland does. All of the health insurance in Switzerland is offered by private insurance companies (thousands of them). The government, however, limits how much profit those companies be made and dictates what is covered and what is not (no more insurance company death squads). (That this is acceptable to those companies is the fact that over 4000 of them are doing that business, the profits being like they were 50-60 years ago and steady and safe, just like insurance companies used to operate.) The Swiss government also forms and reforms risk pools to make sure that the risks are shared widely. So, UH can include private insurance companies as Switzerland does or it can basically relegate them to the high risk end of the spectrum or even eliminate them.

For example, I don’t think UH should cover rare medical events, e.g. the birth of conjoined twins. If we go down the road of “Oh, we can’t let anything bad happen,” we will soon be broke. Rare, almost untreatable cancers, well, that is sad but not an obligation of the many to the few. So, I think UH should focus on the common ailments that are treatable and allow the insurance companies to sell expensive policies to those who want protection from rare life threatening diseases and accidents, e.g. ‘Every bone in his body was broken but we were able to put him back together.”

But, that’s a detail, too.

Battling out the details in a political process is a vain effort and will not inform us. All we need to know is that other countries can produce health outcomes equivalent to, or better that, ours for much less than we currently pay. This tells us that UH is something we can do. Then it is a matter of political will, and unfortunately, power politics.

Addendum Check out The American Health Care System Costs Four Times More Than Canada’s Single-Payer System (and the Public Option Won’t Help)

Here’s a taste: “The average American pays a whopping $2,497 per year in administrative costs — which fund insurer overhead and salaries of administrative workers as well as executive pay packages and growing profits — compared to $551 per person per year in Canada, according to a study published in the Annals of Internal Medicine last month. The study estimated that cutting administrative costs to Canadian levels could save more than $600 billion per year.”

“Despite the massive difference in administrative costs, a 2007 study by the Centers for Disease Control and Canada’s health authority found that the overall health of residents in both countries is very similar, though the US actually trails in life expectancy, infant mortality, and fitness.”


  1. You’re 100% right but I don’t see it happening any time soon. So I guess I’m ready to sign on to any marginal improvement that can be in the mess.

    What always kills me is this meme about government taking away your private health care.

    Who the F has private health care? If you’re not already getting it from the government, you probably getting it from your employer. Aside from that, you have people buying their own insurance but heavily subsidized by Obamacare or State government, some group that is buying minimal or lousy insurance because that is all they can afford, or a small group of wealthy people who really do have private insurance. So only this last group is one who has private insurance. But the way issue is framed, most people – even the ones getting it from the government or their employer – think it is their insurance.


    Comment by James Cross — February 19, 2020 @ 11:17 am | Reply

    • My favorite is “Being able to select my own doctor.” Like we are any good at that. Like we interview dozens of them before selecting one. Like we go to doctor selection fairs to learn about what doctors are available in my area.

      I had an ear infection once and I went to a clinic half way across the city. The doctor who treated me (very well indeed and with almost no waiting involved) indicated that a colleague in her group was much closer to where I lived and I pointed out that his website indicated he didn’t take patients with ear ailments. Such is the system we have. Imagine a system which all doctors have available all other doctors to refer patients to.

      On Wed, Feb 19, 2020 at 11:17 AM Class Warfare Blog wrote:


      Liked by 1 person

      Comment by Steve Ruis — February 19, 2020 @ 11:36 am | Reply

      • The “select your own doctor” thing is a joke in any case. I’ve *never* been able to select a doctor. Like most people, I see whoever the insurance company says I can see. I have no choice in the matter. Not for a hospital, clinic, individual practitioners, cardiologists, none of them. The whole “choose your own doctor” controversy was a strawman from the beginning. I see whoever the insurance company tells me to see, or whoever has an opening when I need an appointment. I do have a regular doctor listed in my records, but I actually haven’t seen him in I don’t know how long. When I go in it’s a PA or NP who does the actual evaluation


        Comment by grouchyfarmer — February 19, 2020 @ 10:32 pm | Reply

        • The best medical advice and service I have received was when I had Kaiser-Permanente insurance. I saw who ever was a available and received, IMHO, excellent health care services.

          On Wed, Feb 19, 2020 at 10:32 PM Class Warfare Blog wrote:


          Liked by 1 person

          Comment by Steve Ruis — February 20, 2020 @ 7:37 am | Reply

        • I don’t know … I have basic Medicare (not Medicare Advantage) and I can see whatever doc I want … and go to whatever Urgent Care or hospital I want. Of course I don’t choose caretakers that won’t accept Medicare payments, but that’s my only qualifier.

          I tried a Medicare Advantage program several years back and found I was paying for services I never used.


          Comment by Nan — February 20, 2020 @ 12:48 pm | Reply

          • My wife and I can see whoever we want to now because of Medicare and our additional coverage, but before this, we had to see whoever our insurance companies would let us see. We had no choice at all.


            Comment by grouchyfarmer — February 20, 2020 @ 1:40 pm | Reply

          • MeToo. Not a problem. Don’t know what people think it is.

            On Thu, Feb 20, 2020 at 12:48 PM Class Warfare Blog wrote:


            Liked by 1 person

            Comment by Steve Ruis — February 21, 2020 @ 11:55 am | Reply

  2. In that list of “administrative costs,” you forgot to include the astounding cost of TV ads … that are so very, very necessary so we’ll all know what the medicine does and when to report abnormalities to our doctor and how to continue to live a happy, healthy life like all those people in the ads that are playing ball, swimming, having folks over for dinner, etc., etc.


    Comment by Nan — February 19, 2020 @ 11:22 am | Reply

    • And the CEOs are so expensive! Amazing that they can be replaced by lowly civil servant!

      On Wed, Feb 19, 2020 at 11:22 AM Class Warfare Blog wrote:


      Liked by 1 person

      Comment by Steve Ruis — February 19, 2020 @ 11:37 am | Reply



    Liked by 1 person

    Comment by john zande — February 19, 2020 @ 12:04 pm | Reply

    • Egad, Newsweek managed to publish the truth?! Their CEO is going to be on the carpet shortly.

      On Wed, Feb 19, 2020 at 12:04 PM Class Warfare Blog wrote:


      Liked by 1 person

      Comment by Steve Ruis — February 19, 2020 @ 12:19 pm | Reply

  4. Actually going to a single payer or Medicare for all system would bring about an economic boom in the private sector. Think of how much employers have to pay for employee health care costs. Not only would companies save huge amounts of money by not having to pay for insurance, most likely those employees would be healthier, with fewer illness related absences.


    Comment by grouchyfarmer — February 19, 2020 @ 10:35 pm | Reply

    • Presumably if those companies were contractually obligated to pay for their employees healthcare, they would either have to pay that money directly to the employees or pay it in taxes so their savings cash wise would be much like the rest of ours in that the whole system would be less costly. The “details” in this are immense, but clearly “the government” will not just start picking up the tab and let everything else sort itself out.

      On Wed, Feb 19, 2020 at 10:35 PM Class Warfare Blog wrote:



      Comment by Steve Ruis — February 20, 2020 @ 7:40 am | Reply

  5. Why wouldn’t we want to cover conditions just because they are rare? It’s not that these conditions are necessarily more expensive – there are plenty of “common” conditions, like heart artery blockage, that can be very expensive. And the thing with the rare conditions is just that – they’re rare, so on per person basis they are not that expensive to cover: if there’s a condition that affects one in a million and costs, say, $1million to treat, it’s going to add just $1 to the life time cost of insurance that spreads the costs over large groups – so, basically, 1.4 cents per year. At the same time, a common and cheap procedure like a flu vaccination, say, at $20 per shot, will cost around $10 per person (assuming half of people actually get it every year) per year to cover.
    The way to bring down the costs should be to pick the cheapest treatment of the few similarly effective, unless there’s a legitimate medical reason to go with a different one, and to pay for the result (a sick person is now healthy) and not for the specific procedures.


    Comment by List of X — February 21, 2020 @ 8:31 pm | Reply

    • I mis-wrote. Instead of rare I meant bloody expensive and the example was separating conjoined twins or really extensive reconstructive surgeries after an accident. I think we should focus on the quite common medical care that people need and not jump into the deep end of the pool financially.

      On Fri, Feb 21, 2020 at 8:31 PM Class Warfare Blog wrote:



      Comment by Steve Ruis — February 21, 2020 @ 9:35 pm | Reply

      • If conjoined twins have to be separated to survive, the procedure should be covered. If we’re talking about a cosmetic surgery to remove the scars, then it probably shouldn’t be.


        Comment by List of X — February 21, 2020 @ 9:45 pm | Reply

        • I am not opposed to jumping into the deep end of the pool. I just think we would be better served easing in a bit. Your way would be simpler, maybe easier to get passed.

          On Fri, Feb 21, 2020 at 9:45 PM Class Warfare Blog wrote:



          Comment by Steve Ruis — February 21, 2020 @ 9:55 pm | Reply

  6. Steve Ruis, I have heard and read conflicting information on the idea of Medicare For All. If we went that way, what would you like to see as an end result?


    Comment by ragnarsbhut — March 4, 2020 @ 3:13 pm | Reply

  7. It’s hard to imagine the Democratic establishment will let Klobucher get the nomination. I have been reading stories about a brokered convention and I am beginning to wonder if that is what the leaders of the Democratic party want. My pick at that point would be Michelle Obama.


    Comment by medicare in pennsylvania — April 13, 2020 @ 8:39 am | Reply

    • I doubt that MO would want the job but I am willing to be surprised.

      On Mon, Apr 13, 2020 at 8:39 AM Class Warfare Blog wrote:



      Comment by Steve Ruis — April 13, 2020 @ 8:45 am | Reply

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